Partnership for Child Health Jacksonville, FL 2011 Quality Improvement Partnership for Child Health Jacksonville, FL 2011

What is Quality? Institute of Medicine Definition of Quality The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

A Medical Home framework… ...and the degree to which practice philosophy, standards and activities lay the foundation to providing care that is: Patient-centered Accessible Continuous Coordinated Comprehensive Compassionate Culturally effective

What is Quality Improvement? Very simply, Quality Improvement (QI) is a method of continuously examining processes and making them more effective.

An ongoing process…. … or formally through QI is a career-long journey, whether informally… … or formally through practice-based structured QI process Maintenance of Certification - American Board of Pediatrics

Why is QI Important? Improve patient health Improve patient experience Increase practice efficiencies Reduce expenses Pay-for-performance Transparency in quality and outcomes

Key Components QI Identifying areas of potential improvement Defining clear objectives (Aim Statements) Structured QI process Measuring and tracking progress Effective team work

Aim Statement What are you trying to accomplish? Answers the first question: What are you trying to accomplish?

Aim statement - SMART SPECIFIC MEASURABLE ACTION-ORIENTED A written statement of the accomplishments expected from team’s improvement effort - SPECIFIC MEASURABLE ACTION-ORIENTED REALISTIC and RELEVANT TIMELY

Aim Statements: which one is the best? We will learn how to implement a medical home quality improvement process at our practice. All members of the medical home team will learn about QI by participating in the AAP EQIPP Medical Home learning module By 1/30/11, all of the medical home team members will have completed the “QI Basics” portion of the AAP EQIPP Medical Home learning module.

Another example We will offer opportunities for families to provide feedback about their child’s visit. We will give an office visit questionnaire to all families at the end of their child’s visit. By February 15, 2011 we will have designed a family feedback survey and a data collection and reporting process. By March 15, 2011 we will have be offering the survey (to be completed at the visit or mailed in from home) to 100% families at the end of their child's visit.

Structured QI Process The Improvement Model - What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement?

PDSA: Plan Do Study Act

PDSA- Plan Do Study Act Analyze the process; determine what changes would most improve it; establish a plan for making improvement; predict results Do Put your change into motion on a small scale or trial basis; collect data Act If the change is working, implement it on a larger scale. If not, refine it or reject it and begin the cycle again Study Check to see whether the change is working; compare to prediction

PDSA: cycles for testing Increase your belief that the change will result in improvement Opportunity for “failures” without impacting performance Document how much improvement can be expected from the change Learn how to adapt the change to conditions in the local environment Evaluate costs and side-effects of the change Minimize resistance upon implementation

Our take on QI Keep it simple, don’t try to change overnight Talk to the experts (colleagues, nurses, other staff, families) Remember – you can’t improve what you can’t (or don’t) measure

Measurement for Quality Improvement Measurement begins with identifying potential improvement areas. Measuring tells a team if the changes they make are making a difference. The team needs just enough data to tell if the change is making an improvement. Should speed improvement, not slow it down. “Measurement” is not the goal.

Medical Home Measurement tools Medical Home Index Medical Home Family Index

B -building blocks and progress summary E - improvement activities, data collection and progress tacking

Medical Home Measurement tools …are based on the premise that medical home is an evolutionary process rather than a fully realized status for most practice settings. The tools quantify "medical homeness" and measure a primary care practice's progress in this ongoing process.

Measurement - and Pursuit of Recognized Standards NCQA Physician Practice Connections® - Patient-Centered Medical HomeTM Web-based data collection tool that provides a framework for QI strategies to achieve NCQA “Medical Home Recognition” NCQA Recognition is the basis for efforts to transform payment systems and enhance compensation from public and private payers.

Effective Team Work Teams harness the knowledge, skills, experience and perspectives of different individuals to make lasting improvements. American Academy of Family Physicians

Before you assemble your QI team…. … you must create an infrastructure within your practice that will support the team's work. American Academy of Family Physicians

Physician leadership is key! Be a QI champion and actively support your team. Without demonstrated endorsement from practice leaders, teams will flounder. American Academy of Family Physicians

Utilize external resources to help you get your teams started. Identify the key people to help keep the QI momentum going, such as an office manager facilitator . Cultivate a spirit of QI within your practice that encourages everyone to improve the quality of services and programs continuously. Utilize external resources to help you get your teams started. Develop staff members' skills in research, data collection and analysis. American Academy of Family Physicians

Recruiting members. …. To work efficiently, QI teams need diversity: people with different skills, experience, knowledge and viewpoints. Staff members who are directly involved with the process under study should be represented on the team. American Academy of Family Physicians

Running effective QI meetings requires… pre-planning by team leader and team facilitator clearly established goals (agenda) group idea generation assigned responsibility and time allotted for each agenda item Refer to tools available on: EQIPP (enrollment required) (http://www.eqipp.org/) Building Your Medical Home toolkit (http://www.pediatricmedhome.org/qib/) A Team Approach to Quality Improvement (http://www.aafp.org/fpm/990400fm/25.html) American Academy of Family Physicians

Where can our practice team learn more about Medical Home Quality Improvement?

Medical Home QI Training

What is EQIPP? AAP EQIPP courses are designed to help you learn how to identify and close the gaps in your practice using practical QI tools. By using EQIPP, you will collect data to measure your current level of care at baseline as you work to improve care through Plan, Do, Study, Act (PDSA) cycles. Course Description Using the learning EQIPPment provided in this program, by the end of the EQIPP Medical Home for Pediatric Primary Care course, you will be able to: - Collect and analyze baseline data to establish a starting point for improvement. - Identify one or more performance gaps in one or more key activities of the medical home. - Create an improvement plan for closing the performance gap(s) in which you: *Identify a specific aim; *Generate ideas for change; and *Consider potential barriers. - Implement change(s) designed to close gap(s). - Collect and analyze follow-up data to measure the results of your improvement efforts. - Create additional improvement plans and repeat the change-improvement cycle until you reach your maximum potential of being a high quality, effective medical home. Activity Details Credit Types: CME Credit Amount: 32.0 Credits Release Date: 2010-Oct-28 Expiration Date: 2013-Oct-28 Registration Required: Yes Cost: $199-229 System Requirements:

The AAP now offers – Medical Home for Pediatric Primary Care

With EQIPP online courses, you can: learn to document improved quality care on a continuous basis earn CME credit meet MOC (American Board of Pediatrics Maintenance of Certification) Part 4: Performance in Practice requirements all at once.

EQIPP guides you through: online work to review content presentation, research linked information, and participate in activities offline work to introduce and implement performance improvement within your own practice

Course Home tab - Provides course goals and objectives Lists Key Clinical Activities Links to key areas within the course (Helpful Links) User can: 1. Browse available content 2. View demo 3. Complete QI Basics Describe what QI is and why it is important; List benefits of applying QI principles in practice; Form an effective team to direct QI efforts in practice; Apply the model for improvement to plan, test, and implement changes that result in measurable improvements; and Recognize that QI requires multiple tests of change and changes to office habits, processes, and systems.

Improvement Activities Enter Baseline Data Analyze Results Aims & Changes Create Improvement Plan Enter Follow Up Data

Learning EQIPPment QI Basics Key Clinical Content Case Studies Team Learning Tools

Useful Tools!

Now what? P P P Step # 4. Implement a quality improvement process Step # 1. Educate and engage all physicians and practice staff Step # 2. Identify the children with special health care needs in the practice Step # 3. Unite the medical home team and assess the current medical home qualities of the practice P P Step # 4. Implement a quality improvement process

Support for Your Practice Practices participating in the Medical Home Implementation Project receive: Reimbursement of EQIPP enrollment fee at AAP Member rate of $199 for one physician in your practice if enrolled by January 31, 2011.  Upcoming Webinar about EQIPP provided by the AAP and Center for Medical Home Improvement (February 28, 2011) Ongoing technical support offered by Partnership for Child Health medical home support staff.

Melana Smith, RN (904) 360-7070, ext 325 melana_smith@doh.state.fl.us Website: www.partnershipforchildhealth.org Melana Smith, RN (904) 360-7070, ext 325 melana_smith@doh.state.fl.us

One Step at a Time….